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Anterior chamber Ahmed aqueous drainage implantation for refractory glaucoma prevention and treatment of complications_2807

By Anna Sanders,2014-10-30 10:16
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Anterior chamber Ahmed aqueous drainage implantation for refractory glaucoma prevention and treatment of complications_2807

    Anterior chamber Ahmed aqueous drainage implantation for refractory glaucoma prevention and treatment of complications

     Author: Wang Hai-ying, Sheng Xiao Jie, Sun Yan,

    Zhu Hongli

     Abstract Objective: To evaluate the anterior chamber

    Ahmed aqueous drainage implantation in the treatment of refractory glaucoma surgery in the prevention and treatment of postoperative complications and improve surgical success rate. Methods: 2003/2005 line between the anterior chamber in my

    hospital Ahmed, after implantation of aqueous drainage in 20 patients with refractory glaucoma in patients with intraoperative and postoperative complications were analyzed retrospectively. Results: The follow-up time of 4 ~ 23mo. The

    average intraocular pressure level from 35.3 ? 5.2mmHg (1mmHg

    = 0.133kPa) reduced to 18.6 ? 4.4mmHg, the success rate was

    90%. 13 cases of complete success (65%), including 4 cases of early hypotony, shallow anterior chamber in 6 cases, hyphema in 4 cases, obstruction of drainage tubes in 3 cases, 1 case of choroidal detachment; five cases of conditions, successful (25% ) including drainage plate fibrosis in 4 cases, an outbreak of choroidal hemorrhage in 1, still need to be complemented by IOP lowering medications to control IOP; two

    cases because of persistent high intraocular pressure leads to failure. Conclusion: The anterior chamber aqueous Ahmed drainage implant surgery and postoperative complications matter a lot more complicated hair, but after a timely and

    appropriate treatment can achieve the desired effect.

     Key words complications of Ahmed valve for refractory glaucoma the anterior chamber

     0 Introduction

     The anterior chamber Ahmed glaucoma valve (AGV) implantation on anterior chamber depth for the application of

    a good refractory glaucoma surgery classic style, its simple, clear anatomical structure, it is appropriate to master. But the AGV implantation and early postoperative prone to shallow anterior chamber, low intraocular pressure and a series of

    complications, such as improper handling will cause injury to the cornea, anterior chamber hemorrhage, and even surgery fails. To improve the success rate of surgery, we have in our hospital since the 2003-12 pre-chamber AGV implantation

    surgery and postoperative complications in patients with symptomatic treatment, and were retrospectively analyzed to compare their preoperative and postoperative intraocular pressure control of AGV implantation effects, analyzed as follows.

     An object and method

     1.1 Object 13 males and 7 females, a total of 20. Age 41 to 78 (mean 51.6) years, ECCE surgery in 4 cases, ECCE IOL implantation in 7 cases, 4 cases, after repeated

    trabeculectomy, neovascular glaucoma in 4 cases, glaucoma, a cataract uveitis cases, preoperative mean IOP 35.3 ? 5.2mmHg

    (1mmHg = 0.133kPa), intraocular pressure lowering medications ineffective, continuous decline in visual acuity.

     1.2 Methods of conventional retrobulbar anesthesia select the appropriate quadrant two rectus intercropping a 90 ?

    range to the basement vault of the conjunctival flap, sneak separate fascia and the sclera, reaching back equator of the eye; in equatorial scleral surface of the fascia organization placed under the 0.4g / L MMC 3 ~ 5min, 20mLNS washing; for

    5mm × 6mm to limbal basement of the scleral flap, equivalent

to 1 / 2 full-thickness sclera to reach within the

    corneoscleral margin of 0.5mm; take Ahmed glaucoma valve, since the drainage tube into the saline solution in order to confirm the valve opening unobstructed. Without any resistance cases, the drainage plate Ahmed glaucoma valve placed between the two rectus sclera surface, and riding across the equator in the eye department, so that drainage tube directly at the center of corneal scleral flap diameter line, in the post-8mm

    with limbal 5-0 nylon line will drain plate front-end 2 fixed

    fixed 2-pin hole and the sclera; syringes with needles on the 7th line of puncture corneoscleral margin. In the corneoscleral margin of the anterior chamber drainage tube

    into the appropriate position, with 2mL syringe containing normal saline with 7 needles OK corneoscleral margin of puncture, the needle parallel to the iris surface into the anterior chamber, anterior chamber needle withdrawn before the

    injection of a small amount of physical saline in order to deepen the anterior chamber; placed drainage tube placed before the front end of its predicted length of the corneal surface, and then cut into a drainage tube into the anterior chamber can be 2 ~ 3mm of the 45 ? ramp up the appropriate

    length of insertion with flat tweezer to live into the anterior chamber drainage tube carefully to ensure the drainage pipe and parallel to the surface instead of the iris and the iris and corneal endothelium contact, and to incline

    towards the drainage tube the inner surface of the cornea; to cover the scleral flap drainage tube, or use some variant of the 4mm × 5mm sclera covering the drainage pipe near the limbus and the flap corners and two at the waist line with

    interrupted 10-0 nylon suture in situ 4-pin. 10-0 nylon suture

    fixation drainage tube in the sclera, and the roots of a temporary drainage tube ligation with 10-0 nylon thread at the

    same time sutured bulbar conjunctiva and fascia. Postoperative subconjunctival injection of dexamethasone 2.5mg and gentamicin 20000 U. Surgical success criteria: complete success: no lowering intraocular pressure in patients with ocular hypertension drug under the conditions of <21mmHg; conditions for success: Topical application of lowering

    intraocular pressure in patients with drug-point eye

    conditions, the intraocular pressure <21mmHg; failure: local administration can not control the intraocular pressure is required Further-line anti-glaucoma surgery.

     2 Results

     Follow-up time of 4 to 23 (average 10.2) mo. Mean

    preoperative IOP 35.3 ? 5.2mmHg, mean postoperative IOP 18.6

    ? 4.4mmHg. The overall success rate of 90%. Postoperative visual acuity was improved two lines or two lines above seven to improve a line or the same 8, 5 decreased vision.

    Complications: 13 patients achieved complete success (65%), including 4 cases of early hypotony, shallow anterior chamber in 6 cases, hyphema in 4 cases, obstruction of drainage tubes in 3 cases, 1 case of choroidal detachment; five cases of

    successful conditions (25%), including drainage plate fibrosis in 4 cases, an outbreak of choroidal hemorrhage in 1, still need to be complemented by IOP lowering medications to control IOP; two cases because of persistent high intraocular pressure

    leads to failure.

     3 Discussion

     Ahmed valve (USA) consists of two parts: first, drainage pipe, the water will drain into the anterior chamber disc at the remote drainage; second drainage plate, through the implantation of drainage plate after plate formation and

    drainage around the disk surface area the same fibrous liquid storage space. Aqueous drainage through the drainage tube into the liquid storage space, and then through the wall of the gap surrounding the fiber is absorbed within the organization to

    achieve the purpose of lowering intraocular pressure. It is unique is that in the drainage plate attached to the front of the mouth with a hose shrink the role of physics in aqueous control room, exit the room there is one made of elastic

    silicone pressure-sensitive valve, the valve in the former Housing Pressure> 1.07 ~ 1.33kPa pm to 2 ~ 3μL aqueous Zeyi

    the slow rate of flow of drainage tray.

     Anterior chamber Ahmed glaucoma valve (AGV) implantation success rate, and intraoperative and postoperative preventive measures in a timely manner closely related. AGV implantation of anterior chamber of the most common and one of the most serious complication of hypotony and shallow anterior chamber

[2]. Mainly due to drainage is too strong, due to early

    postoperative aqueous humor drainage volume larger, this group of patients in six cases of anterior chamber appeared shallow anterior chamber in the formation of its slow, 4 cases of early hypotony may be related to drainage tube in the anterior

    chamber, the Housing the water directly through the drainage tube rapidly excreted rapidly reduce the volume of the anterior chamber; or may be due to the entrance of the anterior chamber drainage tube inserted around the leakage and / or ciliary inhibition, therefore, we believe that excessive restrictions on early postoperative aqueous humor discharge was postoperative hypotony, shallow anterior chamber of the key [2-6], in order to avoid such complications, there have been some improved surgical. The group catheter implantation in some cases an application of a temporary absorbable suture ligation of catheter root method [7], while dense scleral flap suture and catheter mattress suture. If necessary, repair the conjunctiva lines. The patients, 1 patients with choroidal

    detachment, after conservative treatme